Chenier, Francis -S)NEW YORK STATE DEPARTMENT OF HEALTH ` v.
Vital Records Section Burial - Transit Permit
. Name First Middle Last Sex
Francis X. Chenier Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 9, 2012 89 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address The Pines At Glens Falls
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
1,11 Circumstances Investigation
usu Medical Certifier Name Title
0 Suzanne m.Rayeski MD
Address
170 Warren Street,Glens Falls NY 12801
c Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 l6
❑Burial Date Cemetery or Crematory
❑Entombment January 12, 2012 Pine View Crematorium
Address
0 Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
N
O Date Point of
Q.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
I--- Remains are Shipped, If Other than Above
.2 Address
Permission is hereb granted to dispose of the human emains de cribed ab ve as indi' ted.
Date Issued Registrar of Vital Statistics , /j_�—i.--)
(signature
District Numbe 5601 Place Glens Falls
I certify that the remains of the decedent identified above we'e disposed of in accordance with this permit on:
WDate of Disposition I In Ii t- Place of Disposition Zt Val--1 cr. 4r,u,.,
W (address)
to
IX (section) _ (lot number) S (grave number)
QName of Sexton or Perso in Charge Premises Aotitt-Z t�,.Gt
lease print)
Wif--Signature Title Cyr MlATCL
(over)
DOH-1555(02/2004)